Inactive

The Indian Health Service must maintain compliance with the Centers for Medicare and Medicaid Service (CMS), Federal and State regulation, and Agency regulations, such as Indian Health Service’s Third... The Indian Health Service must maintain compliance with the Centers for Medicare and Medicaid Service (CMS), Federal and State regulation, and Agency regulations, such as Indian Health Service’s Third Party-Revenue Accounts Management and Internal Control Policy. Proper reimbursement from medical, in-patient and out-patient service, surgical, dental and other reimbursable services require regulatory compliance. The Centers of Medicare/Medicaid Services (CMS) and other third party payers have precise guidelines for all reimbursable providers and services. These guidelines include documentation requirements that demonstrate medical necessity, correct coding, and billing that depend on data integrity. The Office of Inspector General (OIG) of the United States Department of Health and Human Services (DHHS) believes that all participants in the Medicare and Medicaid programs have an ethical and legal duty to ensure the integrity of their transactions with CMS, Federal and State rules and all applicable regulations. These services will permit service units to move towards strict adherence to CMS, Federal and State compliance guidelines and maintain consistency with the highest standards of business and professional ethics. Coding and billing compliance are key components of Medicare’s condition of participation in fostering and monitoring improved health care outcomes. Indian Health Service (IHS) uses the official coding guidelines for clinical classification systems such as, but not limited to, current editions of International Classification of Disease-Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), American Dental Association (ADA) and complies with the Indian Health Service’s Third Party Revenue Accounts Management and Internal Control Policy, and the Indian Health Service’s statistical and reporting systems for all departments. Service Description The Contractor shall provide a suite of tools that generates accurate, complete and compliant coding. The Contractor shall offer speed and flexibility using a dynamic user display with immediate access to multiple DRGs and reimbursement data. The Contractor shall provide an innovative, patent-protected coder workflow combined with 3Ms exclusive logic-based coding paths with an enhanced ICD-10-PCS table driven design to help simplify coding and improve coder productivity. The Contractor shall provide complications and co-morbidity (CCs and MCCs) as they are defined and displayed. The Contractor shall provide access to view multiple DRG’S and reimbursement impact, as they are dynamically computed. The Contractor will provide Technical Software Support delivered via phone or online by knowledgeable 3M support analysts. The Contractor will provide a “self-service” client-only support website with an extensive, searchable knowledge base and ability to download software and regulatory updates as soon as they are available. The Contractor shall provide Coding-specific support by phone or online form by the 3M Nosology Support Services team of experienced, credentialed coders. Background This is a repeat requirement, was not renewed, which will fulfill the need for HIM Coding. Previous awardees: SRSU Contract: 3M Performance Requirements The Contractor incorporates the latest regulations, rules and guidelines needed to achieve complete, accurate and compliant coding. Market Intelligence/Industry Analysis Said services are in constant demand in current markets. Keeping up with the ever-changing rules and regulations of health care is difficult. Understanding and managing regulatory updates, classification guidelines, payment methodologies and the increasing volume of data in the EHR are formidable challenges. Conclusions and Recommendations 3M Health Information Systems has developed market-leading solutions to help improve organization’s financial health. Annual 3M Software License 3M is current up to date in accurate coding, complete reimbursement and streamline workflows, to assist coders with the task of coding and billing for reimbursement for the Standing Rock Service Unit. 3M has been utilized by Standing Rock Service Unit for coding and billing reimbursements, coders utilize all available software for complete and accurate coding, billing and reimbursement. Was utilized by coders in 2016 and then a new contract was started in June 30, 2020. This contract is a new contract. 3M has been utilized by Standing Rock Service Unit for coding and billing reimbursements, coders utilize all available software for complete and accurate coding, billing and reimbursement. Was utilized by coders in 2016 and then a new contract was started in June 30, 2020. This contract is a new contract. 3M has been utilized by Standing Rock Service Unit for coding and billing reimbursements, coders utilize all available software for complete and accurate coding, billing and reimbursement. Was utilized by coders in 2016 and then a new contract was started in June 30, 2020. This contract is a new contract. 3M IHS technology has led the market in accurate coding, complete reimbursement and streamlined workflows. 3M solutions are supported by a powerful natural language processing (NLP) platform and a dedicated team of health economists, nosologists, data scientists, and clinicians. The contract is based on 1 yr of service w/ 4 option yrs. 3M offers licensing fees for Coding and Reimbursement Software includes: Code finder, DRG-finder, CPT-finder, Clinical Analyzer and DRG Reimbursement Calculations, Coding Reference Library which includes: AHA Coding Clinic, AMA CPT Assistant, Clinical Pharmacology Drug Reference, Dorland’s Medical Dictionary Elsevier’s Anatomy Plates, AHA HCPCS Coding Clinic, Faye Brown’s ICD-9 Coding Handbook & Mosby’s Manual of Diagnostic & Lab Tests. The period of performance estimated to start on March 1, 2022 through February 28, 2027 (Base year with four (4) option years). The estimated dollar amount is $84,632.30. Vendor has all the requirements needed to provide guidance in the coding and billing of medical reimbursements that present to the Standing Rock Service Unit. Only one responsible source and no other supplies or services will satisfy agency requirements. The particular brand name, product, or feature is essential to the Government’s requirements, and market research indicates other companies’ similar products, or products lacking the particular feature, do not meet, or cannot be modified to meet, the agency’s needs. Competition cannot be met with other vendors due to 3M’s proprietary rights that accompany legal ownership of tangible or intangible property. 3M has sole ownership or proprietary rights, legal ownership of the tangible and intangible property. Only 3M qualified technicians are able to provide support assistance, troubleshoot issues and repair software and/or software. It is the only vendor that provides an inclusive package for Coding and Reimbursement resources (as listed above). There is no other software that provides the resources in one program and provides the coding updates on a quarterly basis which is needed for coding and billing compliance. License fee covers multiple users, compared to other software programs that charge per user. The price paid will represent the best value and result in the lowest overall cost alternative to meet the needs of IHS. The price increase for each year are based on the GSA Federal Supply Schedule and covers the updates for all coding reference software including licenses. Market research was completed. There are various Coding software vendors in the industry, OPTUM 360 and AAPC, at comparable prices, but they do not offer all products as 3M. Therefore, the other vendors are not cost effective based on the quantity of service it provides to our healthcare. The requested 3M Health Information Systems has developed market-leading solutions to help improve organization’s financial health. Therefore, 3M has sole ownership or proprietary rights, legal ownership of tangible and intangible property. 3M’s coding references with its powerful natural language processing (NLP) technology and you get auto-suggested codes integrated with clinical document improvement (CDI). NLP empowers coders to use their expertise to review auto-suggested codes and turn clinical documentation into a rich data repository, rather than sifting endlessly through documents and codes. The Contractor incorporates the latest regulations, rules and guidelines needed to achieve complete, accurate and compliant coding. The rights to the license are owned by 3M therefore only qualified technicians working for 3M can provide IT and technical support. Said services are in constant demand in current markets. Keeping up with the ever-changing rules and regulations of health care is difficult. Understanding and managing regulatory updates, classification guidelines, payment methodologies and the increasing volume of data in the EHR are formidable challenges. The software license is an ongoing need for this service or project and no other plans to limit competition is anticipated. There aren’t any other vendors qualified for the service our healthcare unit is requesting.